Alcohol Withdrawal

In 2014, almost 8 percent of the adult population in the United States (those aged 18 and older) suffered from an alcohol use disorder (AUD), which is to say that over 16 million Americans were likely dependent on alcohol, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports. Alcohol dependence is one of the signs of an AUD that can occur when someone drinks alcohol regularly.

Alcohol is a mind-altering substance that changes some of the chemistry in the brain. For instance, alcohol stimulates the production of gamma-aminobutyric acid (GABA) and increases the presence of dopamine in the brain. Both are some of the brain’s chemical messengers used to tell the body how to think, act, or feel. GABA is a kind of natural tranquilizer, turning off the “fight-or-flight” reaction and slowing down some of the functions of the central nervous system like body temperature, respiration, blood pressure, and heart rate. Dopamine tells a person to feel happy, and it is involved in motivation and the reward response. This is why when someone is intoxicated on alcohol, they may feel happy and relaxed, have sluggish movements, display slurred speech, and have slowed reaction times, less anxiety, and fewer inhibitions.

When someone drinks alcohol on a regular basis, the brain may become accustomed to certain levels of alcohol in the bloodstream, creating a tolerance to it. This means that the individual will need to drink more the next time in order for alcohol to have the same effects. After a tolerance builds up and more alcohol is continually consumed, the brain can then become dependent on alcohol’s influence.

Once a dependence is present, as alcohol’s effects wear off, withdrawal symptoms can appear. Alcohol withdrawal syndrome can vary in severity and duration in relation to how dependent a person is on alcohol (i.e., for how long and how much they drank, how young they were when they started drinking, biological and environmental factors, and family history of substance dependence and/or addiction). In extreme cases, alcohol withdrawal can be fatal; therefore, individuals should not try to stop drinking suddenly or without professional help. The New England Journal of Medicine (NEJM) reports that at least half of those battling an AUD will suffer from alcohol withdrawal symptoms. About 3-5 percent of the time, this will result in serious and even potentially-life threatening consequences.

General Timeline for Alcohol Withdrawal

Alcohol is a central nervous system depressant, and during alcohol withdrawal, some of the opposite effects of intoxication may occur. Functions of the central and autonomic nervous system that have become used to being suppressed by alcohol may become hyperactive during withdrawal. As soon as alcohol stops being active in the bloodstream, withdrawal symptoms may start. The autonomic nervous system is in charge of regulating internal organs and bodily functions that people don’t directly control. When it becomes overactive, body temperature may rise, heart rate becomes erratic, blood pressure can increase, and breathing rates may become rapid and shallow. The central nervous system controls the brain and spinal cord, and its overactivity can lead to motor seizures and psychological disturbances, including a heightened stress response.

According to the National Library of Medicine (NLM), alcohol withdrawal syndrome can generally be broken down according to the timeline below.

About eight hours after the last drink:

Anxiety

Agitation

Abdominal cramps

Nausea

Headache

Loss of appetite

Within 24-48 hours after the last drink:

Tremors

Fatigue

Insomnia

Muscle aches

Depression

Sweating

Rapid heart rate

Dilated pupils

Vomiting

Clammy skin

Irritability

High blood pressure

Clouded thinking and lack of mental clarity

Difficulties concentrating

Sensitivity to sound and light

About 1-3 days after the last drink if an extreme form of withdrawal called delirium tremens occurs:

Fever

Hallucinations

Significant confusion

Seizures

About 5-7 days after the last drink:

Alcohol cravings

Sleep disturbances

Mood swings and depressed moods

Symptoms begin to taper off and lessen in severity

Beyond the first week after the last drink:

Physical symptoms subside

Emotional side effects, such as cravings, anxiety, and depression, may continue without treatment

Possible Dangers during Alcohol Withdrawal

Alcohol withdrawal is both physically and emotionally uncomfortable and may even be life-threatening without proper care and attention. Delirium tremens is a serious side effect of alcohol withdrawal that can occur when an individual is significantly dependent on alcohol and suddenly stops drinking. The brain and central nervous system may rebound too quickly with tragic results. Delirium tremens, or DTs, generally occurs in individuals who have been drinking heavily for a long period of time, The New York Times publishes. It may also be more common in those with a prior history of alcohol withdrawal. DTs can be successfully managed with swift and professional medical care.

During alcohol withdrawal, levels of serotonin and dopamine (both chemicals helpful in regulating emotions and elevating moods) may drop significantly, which is what creates the emotional lows that can occur. An individual may have trouble feeling any kind of pleasure in everyday events when these neurotransmitters are depleted. Depression and even suicidal thoughts or tendencies may be commonplace during alcohol withdrawal. Cravings for alcohol may persist, and anxiety and the inability to feel happy may increase the risk for relapse, NIAAA reports.

Relapsing after a period of abstinence is particularly concerning, as an individual is likely to return to drinking at prior rates. Their tolerance is, however, lower after not drinking regularly, and a return to earlier consumption amounts may lead to alcohol poisoning or overdose. The National Council on Alcoholism and Drug Dependence (NCADD) publishes that alcohol consumption and alcohol use disorders, as a lifestyle, are the third leading cause of death in the United States.

How Medical Detox Helps

Since DTs can occur so swiftly without warning, and a few days after stopping drinking, it is never recommended for an individual to stop drinking “cold turkey.” Stopping alcohol use suddenly after dependence exists can cause the brain to struggle to restore balance with multiple negative physical and psychological side effects.

Detox is the safe removal of a toxic substance from the body, and medical detox can provide the most comprehensive and highest level of care. During medical detox, an individual likely remains onsite in a specialized facility where their vital signs and mental health status can be continually monitored. Fluids may need to be administered, as alcohol can dehydrate the body and create an electrolyte imbalance. Some of the body’s essential vitamins and minerals may also be depleted due to alcohol consumption. During medical detox, supplements and balanced nutrition can help to rectify this.

During medical detox, medications can be helpful in managing the symptoms of withdrawal and reducing their severity. Gastrointestinal upset, depression, anxiety, hypertension, and insomnia may all be treated with specific medications during detox, for example. The New York Times reports that benzodiazepine drugs are often the medications of choice during alcohol withdrawal. Long-acting benzodiazepines, such as Librium (chlordiazepoxide) and Serax (oxazepam), can calm the hyperactive functions of the central and autonomic nervous system, thereby helping to minimize withdrawal symptoms. Alcohol itself may be used during detox, as it can be slowly tapered, or weaned off, to prevent DTs and other significant withdrawal symptoms from occurring. During medical detox, any polydrug abuse can also be addressed. Medications can be altered to ensure that no negative interactions between drugs or medications occur.

The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that almost 8 million people over the age of 17 in the United States suffer from co-occurring disorders. This means that they battle more than one disorder at the same time, like an alcohol use disorder and a mental health disorder. Medical detox can be most beneficial when co-occurring disorders are present, as both disorders can be treated and managed at the same time.

Medical detox usually lasts, on average, 5-7 days and may serve to shorten the withdrawal timeline in general. As medical detox serves to establish a level of physical stability, a person can more rapidly move on to address the emotional aspects of alcohol dependence and addiction.

NIAAA publishes that supportive care, which includes a low-light, calm, and quiet environment, as well as the introduction of fluids and proper nutrition, and positive encouragement can be highly beneficial during alcohol withdrawal. A medical detox facility can provide a safe and secure environment along with both pharmacological and supportive care in order to help an individual through alcohol withdrawal and prepare them for admission into a substance abuse treatment program. After balance is restored physically through medical detox, the brain can continue to heal and ongoing emotional withdrawal symptoms can be reduced with continuing treatment.